Socioeconomic Determinants Of Health Research Articles

133 Investigating the Utilization Rate of Fertility Preservation Services Amongst Transgender and Gender Diverse Patients

OBJECTIVES/GOALS: Fertility preservation (FP) allows transgender and gender diverse (TGD) patients undergoing gender-affirming therapy to pursue genetic parenthood. Barriers to care exist leading to its underutilization; while these barriers to care have been investigated, the true utilization rates of FP services by TGD patients are unknown. METHODS/STUDY POPULATION: This study includes a retrospective chart review of adult and pediatric patients from Mayo Clinics Transgender and Intersex Specialty Care Clinic who have provided research authorization. We will assess if FP was discussed and review if the patients proceeded to make appointments with either the Department of Reproductive Endocrinology & Infertility or the Department of Urology. FP terms include semen cryopreservation, sperm extraction, sperm aspiration, testicular tissue cryopreservation, oocyte cryopreservation, embryo cryopreservation, and ovarian tissue cryopreservation. Patient demographic data will be collected to determine associations between utilization rate and age, sex recorded at birth, gender identity, race, ethnicity, and variables related to socioeconomic determinants of health. RESULTS/ANTICIPATED RESULTS: We hypothesize that the rate of FP utilization will be higher for patients who begin to affirm their gender at the age of 25 or older, and for those seeking feminization treatment in comparison to pre-pubescent adolescents, young adults, and transgender men. Of FP options, semen cryopreservation will be most utilized, followed by oocyte cryopreservation; both will be more utilized than embryo cryopreservation, sperm extraction, sperm aspiration, testicular tissue cryopreservation, and ovarian tissue cryopreservation. Employment, and insurance status and coverage, will play a role in FP service utilization after initial consult. This study was approved by Mayo Clinics Institutional Review Board. Data on N=611 patients is expected to be abstracted and analyzed prior to Translation 2022. DISCUSSION/SIGNIFICANCE: This study will be one of the first to examine the rate of FP utilization by TGD patients with respect to the age and timing of gender-affirming therapy initiation. Understanding the rate of utilization of FP services will allow for the creation of age-appropriate education materials for TGD patients pursuing gender affirmation and FP at Mayo Clinic.

Sociodemographic Missed-care Predictors for Pediatric Orthopaedic Telemedicine During COVID-19.

Increased telehealth services may not benefit communities already lacking access to care. Race, socioeconomic status, and insurance type are known to predict missed-care opportunities (MCO) in health care. We examined differences in pediatric orthopaedic telemedicine MCOs during the COVID-19 pandemic, compared with MCOs of in-person visits in a prepandemic time frame. We hypothesized that groups with known health disparities would experience higher rates of pediatric orthopedic telemedicine MCOs. We retrospectively analyzed pediatric orthopaedic telemedicine MCOs during the COVID-19 pandemic lockdown (March-May 2020) and in-person pediatric orthopaedic visit MCOs during a nonpandemic timeframe (March-May 2019). We examined predictors of MCOs including race, ethnicity, language, insurance status, and other socioeconomic determinants of health. There were 1448 telemedicine appointments in the pandemic cohort and 8053 in-person appointments in the prepandemic cohort. Rates of telemedicine MCOs (12.5%; n=181) were significantly lower than in-person MCOs (19.5%; n=1566; P<0.001). Telemedicine appointments with public insurance or without insurance (P<0.001) and being Black or Hispanic/Latinx (P=0.003) were associated with MCOs. There were significant differences between in-person MCOs and telemedicine MCOs among all predictors studied, except for orthopaedic subspecialty team and patient's social vulnerability index. Patients with telemedicine appointments during the COVID-19 pandemic were less likely to experience MCOs than patients with in-person visits during the nonpandemic timeframe. However, when controlling for socioeconomic factors including race, ethnicity, and insurance type, disparities found for in-person visits persisted with the shift to telemedicine. Pediatric orthopaedists should be aware that the use of telemedicine does not necessarily improve access for our most vulnerable patients. Level III.

Disparities in smoking prevalence and associations with mental health and substance use disorders in underserved communities across the United States.

Smoking contributes to the top 3 deadliest cancers, cancers of the lung, colon, and pancreas, which account for nearly 40% of all cancer-related deaths in the United States. Despite historicly low smoking rates, substantial disparities remain among people with mental health conditions and substance use disorders (SUDs). The study examined the prevalence of smoking among adults from underserved communities who are served at federally qualified health centers through an analysis of the 2014 Health Center Patient Survey. Furthermore, the study assessed associations of smoking with co-occurring mental health conditions and SUDs among adult smokers (n = 1735). The prevalence of smoking among health center patients was 28.1%. Among current smokers, 59.1% had depression and 45.4% had generalized anxiety. Non-Hispanic Black smokers had more than 2 times the odds of reporting SUDs (adjusted odds ratio [aOR], 2.13; 95% confidence interval [CI], 1.06-4.30). Individuals at or below 100% of the federal poverty level had more than 2 times the odds of having mental health conditions (aOR, 2.55; 95% CI, 1.58-4.11), and those who were unemployed had more than 3 times the odds for SUDs (aOR, 3.21; 95% CI, 1.27-8.10). The prevalence of smoking in underserved communities is nearly double the national prevalence. In addition, the study underscores important socioeconomic determinants of health in smoking cessation behavior and the marked disparities among individuals with mental health conditions and SUDs. Finally, the findings illuminate the unique need for tailored treatments supporting cancer prevention care to address challenges confronted by vulnerable populations.

Samoprocena zdravstvenog stanja adolescenata

Bearing in mind the social and political events that have taken place in this country in the last decade of the 20th and at the beginning of the 21st century, health of adolescents in this country shows certain specific characteristics. Adolescent health self-assessment, as a subjective health indicator in this population group, depends primarily on how the adolescent perceives themselves, their physical appearance, their health-related behaviours as well as on their communication and relationships with others. The purpose of this review is to gain an insight into the relationship between health indicators and health self-assessment in adolescents, based on the existing literature. The literature reviewed was selected by searching the Pub Med database, for a ten-year period, for references that relate to the adolescent population, i.e., 10to 19-year-olds, in Serbia and world-wide. Studies performed thus far confirmed a statistically significant correlation between demographic data (sex, age, family structure, place of residence) and socioeconomic health determinants, and adolescent health self-assessment. A positive correlation was found related to physical activity as a protective behaviour, while evidence supporting the correlation of a poor health self-assessment with the habit of smoking and a lack of physical activity is consistent across literature. This is not the case with alcohol consumption, while no correlation was found in the majority of studies related to dietary habits. Insights gained in this literature review may be used as evidence-based facts when advocating important issues regarding the preservation and improvement of health in the adolescent population group.

The Impact of Urbanisation on Health Security of Urban Dwellers in Nigeria

Urban centres continue to attract people across social divides. So also is the environment, which changes with constant interactions among urban population who constantly harness environmental resources for their survival. This process comes with its attendant effects that could be either positive or negative. This process explains the rationale behind uneven population patterns among human settlements as well as the lopsided distribution of resources needed to make life worthy of living. The public utilities, health and social services continue to be largely unavailable and where they are available, they are inefficient, shoddy and collapsing. This study is therefore a novel attempt at making a modest contribution to academic discourse on urban studies. It tries to explore the impact of urbanisation on health situation and life expectancy of urban dwellers. The study made use of primary data, which was collected through telephone interviews. The participants in these interviews included scholars in urban studies, public health educators, social workers, and epidemiologists. This was complemented with data from existing literature from scholars in urban and health studies. The results from this study showed that urban environmental problems like inadequate water and sanitation, high infant mortality, lack of rubbish disposal, industrial pollution and its attendant respiratory infections and other infectious and parasitic diseases persist. This is therefore an indication of the deleterious status of socio-economic determinants of health that can hamper a healthy life expectancy.

The coronavirus pandemic and the creation of social inequalities

A basic requirement for the proper functioning of the social system is to allow the whole population to have equal access on health care. In fact, an unequal distribution is noticed when it comes to health but also disease, with socioeconomic determinants affecting both. Unemployment, inability to access health services, living in inappropriate buildings, unhealthy eating habits, low quality of life and social exclusion are some of these factors. Social inequalities, especially those related to chronic diseases, impose a heavy burden on health care system and have adverse effects on patients. The recent pandemic has amplified existing health inequities. Although it is something that affects the entire population, people of lower socioeconomic statuses are expected to record high morbidity and mortality rates. The pandemic demonstrated the need for the state to take the necessary measures and take coordinated action in order to reduce inequalities and protect the most vulnerable groups of the population. The results of these actions will prove to be useful with similar cases in the long run. The purpose of this study is to analyze the socio-economic determinants of health, how to address the morbidity and mortality rates of Covid-19 and to demonstrate the social inequalities, with a focus on chronic diseases. Finally, it aims to present the measures that should be taken by health systems in order to alleviate inequalities in morbidity and mortality rates caused by this new pandemic.

Social Determinants of Adherence to COVID-19 Preventive Guidelines in Iran: A Qualitative Study.

IntroductionAdherence to COVID-19 preventative guidelines may be influenced by a variety of factors at the individual, societal, and institutional levels. The current study sought to investigate the social factors of adherence to those preventive measures from the perspective of health professionals.MethodsIn October 2020, we performed qualitative research in Tehran, Iran, using the directed content analysis method. For the preparation of our interview guide and data analysis, we employed the WHO conceptual framework of socioeconomic determinants of health. Semi-structured interviews were conducted with 15 health professionals and policymakers who were chosen using a purposive sampling approach. MAXQDA-18 software was used to analyze the data. The Goba and Lincoln criteria were used to assess the quality of the results.ResultsThere are 23 subcategories and 9 categories, which include socio-economic and political context (unstable macroeconomic environment, poor management of the pandemic, media and knowledge transfer), cultural and social values (fatalism, cultural norms, value conflicts, social customs), socio-economic positions (livelihood conditions), social capital (social cohesion, low trust), living conditions (housing conditions), occupational conditions (precarious employment), individual characteristics (demographic characteristics, personality traits, COVID-19 knowledge, and attitude), psycho-social factors (normalization of the disease, social pressure, and stigma), and health system leadership (health system problems, not taking evidence-based decisions, non-comprehensive preventive guidelines, non-operational guidelines, inadequate executive committee) were obtained.ConclusionTo limit the new COVID-19 transmission, people must be encouraged to follow COVID-19 prevention instructions. Improving adherence to COVID-19 preventive guidelines necessitates dealing with the complexities of responding to social determinants of those guidelines. Increasing public health literacy and knowledge of COVID-19, informing people about the consequences of social interactions and cultural customs in the spread of COVID-19, strengthening regulatory lockdown laws, improving guarantees for adhering to preventive guidelines, providing easy access to preventive supplies, and strengthening financial support for households with precarious employment are all important.

Measuring Health Equity in Emergency Care Using Routinely Collected Data: A Systematic Review.

Introduction: Achieving equity in health care remains a challenge for health care systems worldwide and marked inequities in access and quality of care persist. Identifying health care equity indicators is an important first step in integrating the concept of equity into assessments of health care system performance, particularly in emergency care.Methods: We conducted a systematic review of administrative data-derived health care equity indicators and their association with socioeconomic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PubMed, and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine.Results: Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care-sensitive condition-related ED visits were the two most frequently used equity indicators. The studies analyzed equity based on seven SEDH: social deprivation, income, education level, social class, insurance coverage, health literacy, and financial and nonfinancial barriers. Despite some conflicting results, all identified SEDH are associated with inequalities in access to and use of emergency care.Conclusion: The use of administrative data-derived indicators in combination with identified SEDH could improve the measurement of health care equity in emergency care settings across health care systems worldwide. Using a combination of indicators is likely to lead to a more comprehensive, well-rounded measurement of health care equity than using any one indicator in isolation. Although studies analyzed focused on emergency care settings, it seems possible to extrapolate these indicators to measure equity in other areas of the health care system. Further studies elucidating root causes of health inequities in and outside the health care system are needed.

People With SUDs at Higher Risk of Breakthrough COVID-19 Infection

People With SUDs at Higher Risk of Breakthrough COVID-19 Infection

GeoDa, From the Desktop to an Ecosystem for Exploring Spatial Data

Since its introduction more than 15 years ago, the GeoDa software for the exploration of spatial data has transitioned from a closed source Windows‐only solution to an open source and cross‐platform product that takes on the look and feel of the native operating system. This article reports on the evolution in the functionality and architecture of the software and pays particular attention to its new implementation as a library, libgeoda. This library, through a clearly structured API, can be integrated into other software environments, such as R (rgeoda) and Python (pygeoda). This integration is illustrated with two small empirical examples, investigating local clusters in a historical London cholera data set and among socioeconomic determinants of health in Chicago. A timing experiment demonstrates the competitive performance of GeoDa desktop, libgeoda (C++), rgeoda and pygeoda compared to established solutions in R spdep and Python PySAL, evaluating conditional permutation inference for the Local Moran statistic.

Socioeconomic Determinants of Health and Their Unequal Distribution in Poland

The purpose of this study is to identify inequities in the distribution of socioeconomic determinants of health within Poland and their impact on the health status of Poles, as measured by mortality rate. We hypothesised that (1) there are inequities in the socioeconomic characteristics within geographically defined population groups and (2) some socioeconomic determinants of health have a particularly strong impact on the health status of Poles. Poland is administratively divided into three levels: voivodeships, powiats and gminas. We used a dataset covering all 380 powiats in Poland for the year 2018. We employed a two-stage nested Theil index and Herfindahl–Hirschman Index. In order to identify which of these determinants has the strongest impact on health, we conducted a regression analysis. The study revealed some inequities in the distribution of socioeconomic determinants of health. The mortality rate can be partly understood from variations within voivodeships in the distribution of health determinants. Important national inequalities were found in the case of two determinants, which simultaneously proved their significant impact on Poles’ health in the regression analysis. Thus, type of employment and access to modern infrastructure should be of particular concern for public authorities.

SUDs increase risk for breakthrough COVID‐19 infections

Breakthrough COVID‐19 infections — those that occur even if fully vaccinated — are higher for patients with substance use disorders (SUDs) than people without. While the risk even for patients with SUDs for breakthrough infections was low overall, a study published by researchers at the National Institute on Drug Abuse (NIDA) and Case Western Reserve University last week found that it was relatively higher compared to people without SUDs, mainly when considering marijuana. Using electronic health records of almost 580,000 fully vaccinated people in the United States, the researchers found that the actual risk for breakthrough infections was highest for people with co‐occurring health conditions and adverse socioeconomic determinants of health (lack of adequate housing, for example). These co‐occurring problems are more common in people with SUDs and are primarily responsible for increasing the risk of breakthrough infections, except for cannabis, which, when other factors were controlled for, still added to the risk.

Increased risk for COVID-19 breakthrough infection in fully vaccinated patients with substance use disorders in the United States between December 2020 and August 2021.

Individuals with substance use disorders (SUDs) are at increased risk for COVID‐19 infection and for adverse outcomes of the infection. Though vaccines are highly effective against COVID‐19, their effectiveness in individuals with SUDs might be curtailed by compromised immune status and a greater likelihood of exposures, added to the waning vaccine immunity and the new SARS‐CoV‐2 variants. In a population‐based cohort study, we assessed the risk, time trends, outcomes and disparities of COVID‐19 breakthrough infection in fully vaccinated SUD patients starting 14 days after completion of vaccination. The study included 579,372 individuals (30,183 with a diagnosis of SUD and 549,189 without such a diagnosis) who were fully vaccinated between December 2020 and August 2021, and had not contracted COVID‐19 infection prior to vaccination. We used the TriNetX Analytics network platform to access de‐identified electronic health records from 63 health care organizations in the US. Among SUD patients, the risk for breakthrough infection ranged from 6.8% for tobacco use disorder to 7.8% for cannabis use disorder, all significantly higher than the 3.6% in non‐SUD population (p<0.001). Breakthrough infection risk remained significantly higher after controlling for demographics (age, gender, ethnicity) and vaccine types for all SUD subtypes, except for tobacco use disorder, and was highest for cocaine and cannabis use disorders (hazard ratio, HR=2.06, 95% CI: 1.30‐3.25 for cocaine; HR=1.92, 95% CI: 1.39‐2.66 for cannabis). When we matched SUD and non‐SUD individuals for lifetime comorbidities and adverse socioeconomic determinants of health, the risk for breakthrough infection no longer differed between these populations, except for patients with cannabis use disorder, who remained at increased risk (HR=1.55, 95% CI: 1.22‐1.99). The risk for breakthrough infection was higher in SUD patients who received the Pfizer than the Moderna vaccine (HR=1.49, 95% CI: 1.31‐1.69). In the vaccinated SUD population, the risk for hospitalization was 22.5% for the breakthrough cohort and 1.6% for the non‐breakthrough cohort (risk ratio, RR=14.4, 95% CI: 10.19‐20.42), while the risk for death was 1.7% and 0.5% respectively (RR=3.5, 95% CI: 1.74‐7.05). No significant age, gender and ethnic disparities for breakthrough infection were observed in vaccinated SUD patients. These data suggest that fully vaccinated SUD individuals are at higher risk for breakthrough COVID‐19 infection, and this is largely due to their higher prevalence of comorbidities and adverse socioeconomic determinants of health compared with non‐SUD individuals. The high frequency of comorbidities in SUD patients is also likely to contribute to their high rates of hospitalization and death following breakthrough infection.

Can digital health technologies exacerbate the health gap? A clustering analysis of mothers’ opinions toward digitizing the maternal and child health handbook

BackgroundThe use of mobile health has increased worldwide, but along with its increased utilization comes the risk of the digital divide, inequity in access to information and communications technologies, exerting greater influence on health inequity caused by socioeconomic determinants of health. There is a growing need to investigate whether the digitization of existing health interventions has a risk of worsening the health gap. MethodsWe investigated the attitudes of mothers and pregnant women toward digitization of the Maternal and Child Health Handbook (MCHH), a popular personal health record (PHR) used by almost every pregnant woman or mother in Japan, using a cross-sectional survey. We determined sociodemographic factors associated with favorable opinions toward digitization using a multivariate regression model. We then grouped the participants using partitioning around medoids clustering, a machine-learning approach, to interpret their varying attitudes toward digitization in light of their sociodemographic characteristics as well as their affinity toward the paper MCHH. FindingsHigher income and educational level, older age, and less reliance on the MCHH were significantly associated with favorable opinion toward digitization. Clustering analysis identified four latent clusters. The cluster with the highest socioeconomic status (SES) was the most favorable toward digitization, while two clusters with the lowest SES, one of which relied heavily on the paper MCHH, were less favorable of digitization compared to the high SES cluster. The final cluster was comprised of mothers with the experience of raising multiple children and did not rely heavily on the MCHH. InterpretationOur study identified a socioeconomic divide in opinions toward digitization of an existing health intervention. A hasty digitization may result in an unbalanced uptake of the digitized health intervention among different social classes.

Changes in socioeconomic determinants of health in a copper mine development area, northwestern Zambia

In 2011, an industrial copper mine was developed in northwestern Zambia. A health impact assessment was conducted to anticipate and address potential health impacts. To monitor these impacts, three community-based surveys were conducted in the area (2011, 2015 and 2019). We analysed these data to determine how household socioeconomic indicators – considered determinants of health – have changed in the area over time. In mine-impacted communities, between 2011 (pre-construction) and 2019, significant changes were observed for: (i) average household size (-0.6 members); (ii) proportion of mothers that have not completed primary school (+20.4%); (iii) ownership of economic assets (e.g. phones +29.3%; televisions +15.6%); (iv) access to safe drinking water (+27.4%); and (v) improved housing structures (e.g. finished roof +58.6%). When comparing changes between 2015 and 2019 in impacted communities to nearby comparison communities, there was (i) an increased proportion of mothers that had not completed primary school in comparison communities vs. no change in impacted communities; and (ii) increased ownership of economic assets in impacted vs. comparison communities in 2019. This study found generally positive changes in the socioeconomic development of impacted compared to comparison communities, with the most pronounced improvements in the early phases of mine development.

Mental Health Impact of Gender-Based Violence Amid COVID-19 Pandemic: A Review

Gender-based violence (GBV) and poor mental health have received particular attention among healthcare professionals, policymakers, and researchers amid the COVID-19 pandemic. This paper presents a review of available literature to understand the dynamics of GBV and its mental health impact in the context of COVID-19. Confinement and control by abusive partners, social and economic disruption, and restricted access to healthcare services were identified as the main contributing factors of GBV. The paper elaborates on the contribution of broader socioeconomic determinants of health as well as cultural and societal factors of victimization in shaping GBV by placing specific populations or individuals in a more vulnerable position within the society based on their gender. Socioeconomic determinants included socioeconomic status, education, migration and racial, ethnic, or gender-based minoritisation. Cultural and societal factors of victimization are mostly related to gender-based structural power discrepancies and communication patterns. Evidence suggests a complex relationship between COVID-19 specific stressors, such as health anxiety and intolerance of uncertainty, GBV, and mental health issues. COVID-19 stressors might directly trigger the mechanism of aggression and cause physical or psychological violence and associated mental health implications in victims, or it might be mediated by pre-existing mental health issues experienced by perpetrators. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.17-25

Effect of treatment sequence on mortality in advanced-stage endometrial cancer

<h3>Objectives:</h3> The aim of this study was to assess for an association between the sequence of surgical and systemic treatment and overall survival in patients with Stage IV endometrial cancer, as well as to identify prognostic factors for mortality. <h3>Methods:</h3> The National Cancer Database (NCDB) was queried for cases of endometrial cancer diagnosed between 2006 and 2015. These cases were further narrowed to include only International Classification of Diseases for Oncology (ICD-O) histologic codes of adenocarcinoma or endometrioid adenocarcinoma and FIGO stage IV disease. Exclusion criteria were: reference date prior to date of diagnosis; unknown treatment sequence; intraoperative chemotherapy use; and hormonal or immunotherapy as first-line systemic therapy or unknown hormonal or immunotherapy use. Three groups were defined according to sequence of administration of surgery and systemic therapy. Overall survival (OS) was compared by calculating hazard ratios for death via Cox regression analysis. The Incomplete Treatment (IT) group received surgery alone, systemic therapy alone, or no treatment. The Primary Surgery (PS) group received surgery before systemic therapy. The Interval Surgery (IS) group had neoadjuvant systemic therapy followed by surgery, with or without further systemic therapy after surgery. Subanalyses were performed to assess the impact of post-IS systemic therapy, age, ethnicity, insurance status, and Charlson-Deyo score on OS. Analysis was performed using STATA.16. <h3>Results:</h3> A total of 8,520 cases of FIGO Stage IV endometrial adenocarcinoma were identified using the criteria above. Median OS in months for each treatment sequence group was 7.2 for IT, 35.7 for PS, and 30.7 for IS. Regardless of treatment sequence, receiving both surgical and systemic therapy improved OS compared to receiving only one or neither treatment. The hazard ratio (HR) for death for PS compared to IT was 0.38 (95% CI 0.36-0.40) and for IS compared to IT was 0.41 (95% CI 0.36-0.47), p<0.0001 for both. There was no significant difference in survival for IS compared to PS (HR 1.10, 95% CI 0.96-1.24, p=0.18). Stratification of IS cases by administration of further systemic therapy after surgery yielded the same result. Patient groups with worse OS (p<0.0001 for all) included: age >50 years (HR 1.18, 95% CI 1.08-1.30), non-Hispanic Black compared to non-Hispanic White (HR 1.27, 95% CI 1.17-1.37), and presence of medical comorbidities reflected by Charlson-Deyo score of 1 or more. Patients with private insurance had better OS than uninsured patients (HR 0.80, 95% CI 0.71-0.90, p<0.0001) but the same was not true for government insurance. <h3>Conclusions:</h3> This retrospective survival analysis of NCDB data for FIGO Stage IV endometrial adenocarcinoma illustrated a benefit to receiving both systemic and surgical treatment over receiving only one or neither form of therapy. No difference in mortality was identified between primary surgery with adjuvant systemic therapy and neoadjuvant systemic therapy with interval surgery, even when accounting for additional chemotherapy after surgery. The decision whether to begin treatment with surgery or chemotherapy will thus depend on nuanced clinical factors specific to each patient. Patient factors associated with worse mortality included age >50 years, Non-Hispanic Black ethnicity, lack of insurance, and presence of medical comorbidities. These findings indicate a need to address the socioeconomic determinants of health contributing to these disparities in mortality.

Comparative analysis of indicators that determine the effectiveness of the implementation of socio-economic determinants of health in Europe and Ukraine

The introduction of national strategies aimed at improving the well-being of the population of the country is one of the current approaches to reforming the public policies of the countries of the world. It is the socioeconomic determinants of health that determine the conditions in which people are born, grow, live and getting old, as well as the spheres of influence on these conditions, such as public policy, state of economic development, demographic trends, etc.&#x0D; The aim. In this way, our research has focused on a comparative analysis of macroeconomic indicators that determine the effectiveness of socioeconomic determinants of healthсare in Europe and Ukraine, that are used to provide scientific justification for the construction of humanistic models for the provision of pharmaceutical care to the population in the context of the rapid stratification of Ukrainian society according to socioeconomic indicators.&#x0D; Materials and methods. The research methodology is based on the principles of systems analysis and an interdisciplinary scientific and systemic approach. The study used the empirical method, the method of comparative analysis and synthesis of statistical data, the graphical method.&#x0D; Results. A comparative analysis of the socioeconomic determinants of health in the countries of the European region and in Ukraine was carried out on three levels of indicators: the level of health-care expenditure, the structure of health-care expenditure and expenditure on medicines.&#x0D; The analysis revealed that in 2019, the average health expenditure of the countries analyzed was 8.2 % of GDP. Only two of the 34 countries - Ukraine and Turkey - have a rate below the 5 % that recommended by WHO.&#x0D; Public health financing schemes and compulsory health insurance are the main funding mechanisms in all countries, with the exception of Cyprus. Ukraine, Russia, Greece, Latvia and Bulgaria have the largest share of direct costs to patients as a source of health care financing.&#x0D; The results of the analysis of the medicine expenditure indicator as a proportion of total health expenditure showed that the highest level was in Bulgaria (35.4 %), the lowest in Denmark (6.4 %). Overall, five countries have high levels of pharmaceutical expenditures.&#x0D; In most European countries, the cost of purchasing medicines has been found to range from 346 to 619 USD per person per year. The highest value of this indicator from the European region is in Switzerland (894 USD per person), and the lowest is in Ukraine (73 USD).&#x0D; Based on the results of the comparative analysis, the countries were grouped according to key indicators into three categories - high, medium and low.&#x0D; Conclusions. A comparative analysis of key indicators of the socio-economic determinants of health in the country of the European region has been carried out

Impact of Race and Socioeconomics Disparities on Survival in Young-Onset Colorectal Adenocarcinoma—A SEER Registry Analysis

Simple SummaryThe results of this study show the effects of socio-economic determinants, such as higher income levels, high school education, private insurance, and married marital status, have favorable survival in patients with young-onset colorectal cancer (YoCRC). Moreover, most of the positive social factors are often interrelated. The inclusion of these factors could further prognosticate and help with healthcare resource allocation for successful interventions through public health measures. Colorectal cancer awareness, knowledge, and even utilization of medical services would differ with the education and health literacy.Introduction: We aimed to assess the impact of socio-economic determinants of health (SEDH) on survival disparities within and between the ethnic groups of young-onset (<50 years age) colorectal adenocarcinoma patients. Patients and Methods: Surveillance, epidemiology, and end results (SEER) registry was used to identify colorectal adenocarcinoma patients aged between 25–49 years from 2012 and 2016. Survival analysis was performed using the Kaplan–Meir method. Cox proportional hazards model was used to determine the hazard effect of SEDH. American community survey (ACS) data 2012–2016 were used to analyze the impact of high school education, immigration status, poverty, household income, employment, marital status, and insurance type. Results: A total of 17,145 young-onset colorectal adenocarcinoma patients were studied. Hispanic (H) = 2874, Non-Hispanic American Indian/Alaskan Native (NHAIAN) = 164, Non-Hispanic Asian Pacific Islander (NHAPI) = 1676, Non-Hispanic black (NHB) = 2305, Non-Hispanic white (NHW) = 10,126. Overall cancer-specific survival was, at 5 years, 69 m. NHB (65.58 m) and NHAIAN (65.67 m) experienced worse survival compared with NHW (70.11 m), NHAPI (68.7), and H (68.31). High school education conferred improved cancer-specific survival significantly with NHAPI, NHB, and NHW but not with H and NHAIAN. Poverty lowered and high school education improved cancer-specific survival (CSS) in NHB, NHW, and NHAPI. Unemployment was associated with lowered CSS in H and NAPI. Lower income below the median negatively impacted survival among H, NHAPI NHB, and NHW. Recent immigration within the last 12 months lowered CSS survival in NHW. Commercial health insurance compared with government insurance conferred improved CSS in all groups. Conclusions: Survival disparities were found among all races with young-onset colorectal adenocarcinoma. The pattern of SEDH influencing survival was unique to each race. Overall higher income levels, high school education, private insurance, and marital status appeared to be independent factors conferring favorable survival found on multivariate analysis.

A County-Level Analysis of Socioeconomic and Clinical Predictors of COVID-19 Incidence and Case-Fatality Rates in Georgia, March-September 2020.

The global COVID-19 pandemic has affected various populations differently. We investigated the relationship between socioeconomic determinants of health obtained from the Robert Wood Johnson Foundation County Health Rankings and COVID-19 incidence and mortality at the county level in Georgia. We analyzed data on COVID-19 incidence and case-fatality rates (CFRs) from the Georgia Department of Public Health from March 1 through August 31, 2020. We used repeated measures generalized linear mixed models to determine differences over time in Georgia counties among quartile health rankings of health outcomes, health behaviors, clinical care, social and economic factors, and physical environment. COVID-19 incidence per 100 000 population increased across all quartile county groups for all health rankings (range, 23.1-51.6 in May to 688.4-1062.0 in August). COVID-19 CFRs per 100 000 population peaked in April and May (range, 3312-6835) for all health rankings, declined in June and July (range, 827-5202), and increased again in August (range, 1877-3310). Peak CFRs occurred later in counties with low health rankings for health behavior and clinical care and in counties with high health rankings for social and economic factors and physical environment. All interactions between the health ranking quartile variables and month were significant (P < .001). County-level Gini indices were associated with significantly higher rates of COVID-19 incidence (P < .001) but not CFRs. From March through August 2020, COVID-19 incidence rose in Georgia's counties independent of health rankings categorization. Differences in time to peak CFRs differed at the county level based upon key health rankings. Public health interventions should incorporate unique strategies to improve COVID-19-related patient outcomes in these environments.